The association of retinopathy and low GFR in type 2 diabetes

Aims: We sought to determine characteristics which strengthen the association between markers of diabetic kidney disease and retinopathy. Methods: Multivariate regression analyses of NHANES 2005-2008 assessed the association of retinopathy with renal insufficiency and albuminuria. Analyses were stratified to evaluate ethnicity/race, obesity, and use of renin-angiotensin-aldosterone system antagonists as effect modifiers of this relationship. Results: Of 269 participants with renal insufficiency, 35% had no microalbuminuria and no retinopathy; 16.1% had retinopathy with no microalbuminuria; 27.1% had microalbuminuria and no retinopathy and 22% had both microalbuminuria and retinopathy. Stratified, multivariate logistic regression analyses demonstrated retinopathy to be significantly predictive of renal insufficiency only in nonHispanic Blacks (OR = 2.7; 95% CI 1.2, 6.1), obesity (OR = 2.6; 95% CI 1.3, 5.5) and in those participants not using renin-angiotensin-aldosterone blockers (OR = 2.5; 95% CI 1.1, 5.7). Analyses showed an independent relationship between retinopathy and albuminuria only when albuminuria was modeled continuously. Conclusions: In older onset diabetes, the absence of albuminuria and retinopathy is common among individuals with renal insufficiency. The relationship between microvascular complications of the eye and kidney may vary according to ethnicity, obesity and use of renin-angiotensin-aldosterone antagonists. These findings need to be confirmed in other large, diverse cohorts. (C) 2012 Elsevier Ireland Ltd. All rights reserved.